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The time interval between the injury and initiation of management should be considered for patients who have sustained trauma to improve patient outcomes.

The optimal destination for the majority of patients with major trauma is a MTC. A pre-hospital triage tool should be used to differentiate between patients who should be diverted to a MTC and those who could be taken initially to a TU for treatment.^19,30 Major trauma patients should only be taken to a TU if the patient...

MTCs should have a clear point of contact to provide clinical advice via clearly identified pathways and local tier arrangement to other providers within the network. This includes advice during the pre-hospital stage and while patients are awaiting transfer to MTCs for definitive treatment.

The anaesthetist plays a key role in the multidisciplinary team who apart from being involved in airway management in major trauma patients, should provide input into the recognition and management of acute physiological derangement, haemorrhage, and shock.

Handovers for patients requiring emergency trauma surgery should be structured to ensure continuity of care. Handover protocols should include clear documentation of care delivered and the future treatment plan for the patient.^18,31

Local policies should ensure that National Institute for Health and Care Excellence (NICE) recommendations and quality standards for major trauma services are met and should be agreed with the regional trauma network.^19,20

There should be local policies in place to meet the quality standards developed by NICE for:²⁰

• patients with major trauma who cannot maintain their airway and/or ventilation to have drug‑assisted rapid sequence induction of anaesthesia and intubation within 45 minutes of the initial call to the emergency services
• patients who have had urgent three-dimensional imaging for major trauma have a...

Initial management should follow the adult trauma life support principles with management of airway, breathing and circulation, together with cervical spine stabilisation occurring in parallel rather than in sequence.²² Local guidelines should be followed to ensure that the appropriate tier of trauma call response is made.

Pain management pathways should be followed for chest wall injuries including provision for early epidural or nerve blocks in patients with multiple rib fractures.²³

Assessment and management for a cervical spine injury should follow pre agreed existing NICE and British Orthopaedic Association guidance.^24,25 Spinal clearance protocols should be embedded into practice.²⁶